Your reviews are arriving slower than a year ago — how a practice can tell, and what a normal pace is

The short version. The review count on a Google listing only ever goes up, so a practice whose reviews have halved still looks fine from the outside — and from the inside, if the count is the only thing anyone checks. The honest measure is pace: your last six months against the same six months a year earlier. For a med spa in the markets we measure, the median practice receives between two and four and a half Google reviews a month and the top quarter six to nine; dentists run higher, dermatologists and surgeons lower. A practice that has fallen well under its own year-ago pace almost always has an ordinary cause — the ask stopped being made — and, unlike a café, you hold the patient record, so the fix is a message you already send.

This page is for practices that hold a patient record: med spas, dental and orthodontic practices, dermatology, plastic surgery, IV therapy, weight-loss clinics. If your customers pay and walk out with no record, the walk-in version is how to get more Google reviews when customers pay and leave.

Why doesn't the review count tell you?

Three reasons, and they compound.

The count can't fall. A listing with 240 reviews had 220 a year ago and 190 the year before; it reads as a steadily growing practice whether those 20 arrived in one busy quarter or dribbled in at two a month. Nothing on the profile says when.

The reader sees the count and the rating, in that order. On the map and in the search result, a practice is "4.9 (240)". The reader who sorts by Newest — which is how a patient comparing two clinics actually reads — sees something different: the date on the top review. A listing whose newest review is four months old tells that patient the practice is quiet, or closed, or careless, before they read a word.

A slowdown feels like nothing. Nobody notices the review that didn't arrive. A one-star review is an event; a month with no reviews at all is an absence, and absences don't get discussed at the Monday meeting.

Google, for its part, does not tell you either. Its own missing or delayed reviews page explains that "reviews are checked to ensure they comply with our policies. In some cases, this process might take a few days," and that "reviews removed for policy violations won't be restored" — useful when one review vanishes, silent on whether your pace has changed.

How do you measure your own pace honestly?

The comparison that holds up is the last six months against the same six months a year earlier — the same window on both sides, so the seasonality of your practice (the pre-summer rush, the December lull) cancels out instead of masquerading as a trend.

By hand it is only approximate, because Google shows relative dates — "3 months ago", "a year ago" — and "a year ago" covers everything from twelve to twenty-three months. The rough version, in about ten minutes:

1. Open your listing on Google, choose Newest, and count the reviews marked anywhere up to "6 months ago". Call that A.
2. Keep scrolling and count the reviews marked "a year ago". That label spans about twelve months, so halve the count to get six months' worth. Call that B.
3. Your change is (A − B) ÷ B. Ten then, six now, is −40%.

The precise version — the same 182 days on each side, by date — needs the review dates exported or a tool that holds them; the rough one is enough to tell "about the same" from "half".

Three traps that produce a false alarm:

• Too few to compare. Under about ten reviews in the earlier window, the arithmetic is noise. Four then, two now, is not a 50% collapse; it's two reviews.
• A partial month. Six months back from the 3rd of the month is not six months back from the 28th. Count by date, not by calendar month.
• The opening year. A practice's first year carries friends, family, staff and the first grateful patients; the second year is what normal looks like. A year-two decline from a year-one surge is expected, not a problem — unless year three is lower again.

If you'd rather not count, that comparison is a tile on Oh Local's dashboard once a listing is claimed — the six months, the same six a year earlier, and the arithmetic between them.

What is a normal pace for a practice?

These are medians from public Google listings we audited in September 2026, reading each listing's newest 50 reviews. "Top quarter" is the pace at the 75th percentile — one practice in four receives at least this many.

Two things to read off it. First, the spread inside a category is wide: the top quarter of Dallas med spas receives more than twice the median, and a dermatologist in the top quarter receives nearly four times the median. Pace is not fixed by what you do; it is set by whether anyone asks. Second, the practice categories are quiet compared with the businesses next door — the median Dallas restaurant receives 9.3 reviews a month and a nail salon 7.7 — which is exactly why one slow quarter shows on a practice's profile in a way it never would on a restaurant's.

So the benchmark for a med spa is roughly: under two a month is below the middle of the market; six or more puts you in the top quarter. The full tables by market, including the ten practices in each city that answer the most of their reviews, are in the Dallas, Miami, Fort Lauderdale, Scottsdale and Phoenix reports.

What share of practices are actually slowing?

Honest answer: for practices, we don't know yet, and this section is about why — because a number we could have printed would have been wrong.

Our audit reads the newest 50 reviews of a practice's listing. A listing only enters a year-over-year comparison when those 50 reach back eighteen months, which is true of the quiet practices and never of the busy ones — a med spa that sped up to six a month has 50 reviews inside nine months and drops out of the sample by construction. Of the 337 med spas in the five market reports, 50 qualified, and 41 of them were slowing. That is a true count and a useless one: the filter picks the decliners.

Where we read deeper, the figure is fair. In Dallas restaurants, read to 300 reviews per listing, 187 carry a full year of history and 58% of them are receiving reviews more slowly than twelve months ago, with a median change of −11%. A slowing pace is the ordinary condition of a local listing, not a crisis — the question for your practice is whether yours is slowing faster than that.

To answer it for practices we would need to read about 150 reviews per listing rather than 50, so the busy ones stay in the sample. That is on our list; when the number exists it will be here, with its sample size.

Why do reviews slow down at a practice?

The causes an owner can check in an afternoon, in the order we'd check them:

• The person who asked left. At most practices one front-desk person or one nurse did the asking, unofficially. When they leave, the asking leaves with them and nobody notices for six months.
• The after-visit message changed. A switch of booking or practice-management software, a template "cleaned up," a text feature turned off in a settings migration. The review link was in that message; now it isn't.
• The link changed. A re-verified profile, a suite number, a second location — the link on your cards and in your templates can point to an old or merged listing. Test it from a phone that isn't signed in to the practice's account.
• The ask moved to the wrong platform. Patients asked for Yelp reviews at a practice whose patients are on Google; a "leave us a review" that opens a form on your own site.
• The opening surge ended. See above. Not a cause; a baseline correcting.
• A quiet quarter that really was quiet. Fewer patients, fewer reviews. Your booking system knows; compare visits year over year before assuming the asking is the problem.

What does a practice do about it?

You hold the record. That is the advantage a café or a salon does not have, and it is why the fix is smaller than it looks.

1. Put the ask in the message you already send. Your booking or practice software sends something after a visit — a thank-you, a follow-up, a rebooking prompt. Add one line with your Google review link. One link, the same for every patient.
2. Ask everyone, offer nothing. Google's policy allows businesses to "solicit or encourage the posting of content that does represent a genuine experience, without offering incentives," and its help page tells you how: "ask customers to visit a Google link or scan a QR code." No discount, no "if you were happy," no tablet at checkout. The rules are the same for a practice as for anyone else — the full rulebook is here.
3. Keep the ask free of the visit. The message asks for a review; it doesn't mention what the patient came in for. Same discipline as the reply.
4. Reply to what comes in, inside the rules. A practice's replies carry a constraint a restaurant's don't — HIPAA-safe review replies covers it — and the med spas that reply to nearly all of their reviews are the ones patients see as attentive: in Dallas, 42% of med spas answer nine reviews in ten, and 8% have never replied at all.
5. Measure it monthly, the same window both sides, or have it measured for you and flagged when it slips (see how Oh Local can help). What you're watching for is not a number but a change: this six months against the same six a year ago.

How Oh Local helps with this

The free audit reads your public listing first — reply rate, the reviews still waiting for an answer, the oldest of them — so you have your own numbers to put beside the table above. Once you've claimed your page, the dashboard shows the comparison above from your own reviews: this six months, the same six a year earlier, and the change between them, refreshed as reviews arrive. When that change reaches −30%, it becomes an action in your list, with the industry median beside it, before it becomes a quiet profile. Every new review arrives with a reply drafted for a practice — thanks for the words, never confirmation of the visit — so replying takes a press, not an afternoon. We don't promise a pace, and no one honestly can; we make the number visible and keep it in front of you.

FAQ

How many Google reviews a month is normal for a med spa?

In the five markets we measured in September 2026, the median med spa received 2.0 (Phoenix), 2.1 (Fort Lauderdale), 2.9 (Dallas), 3.2 (Scottsdale) and 4.5 (Miami) Google reviews a month, and the top quarter six to nine. Under two a month is below the middle of the market; six or more is where the busiest quarter of practices sits. Dental practices run higher (a median of 6 a month in Dallas); dermatologists and plastic surgeons lower (around 1 a month).

Why did my Google reviews stop coming in?

Usually because the asking stopped, not because patients changed: the staff member who asked left, an after-visit message template lost its review link, or the link points to an old listing. Check those three before anything else, and compare patient visits year over year to rule out a genuinely quieter period. Google also holds reviews for a policy check that "might take a few days," so a single missing review is not a trend.

Can Google reviews disappear from my listing?

Yes. A reviewer can edit or delete their own review at any time, and Google's help page says reviews removed for policy violations "won't be restored." Google may also temporarily disable reviews on some profiles, and reviews can be removed after a profile is reinstated. A handful vanishing is normal; a count that stops growing is a pace problem, not a removal problem.

Is a practice allowed to ask patients for Google reviews?

Yes, under the same rules as any business: Google permits asking for reviews "without offering incentives," and its help page suggests a link or a QR code. Ask every patient the same way, offer nothing in return, don't screen out unhappy patients, and keep the message itself free of anything about the visit. Replying is where a practice's privacy obligations bite — see the HIPAA-safe replies guide.

How do I compare my review pace to last year?

Count the reviews Google marks up to "6 months ago", then the reviews marked "a year ago" (a label that spans about twelve months, so halve that count), and divide the difference by the earlier figure. Use the same six-month window on both sides so seasonality cancels out, treat the result as noise if the earlier window holds fewer than about ten reviews, and remember the by-hand version is approximate because Google shows relative dates. Oh Local's dashboard does the same arithmetic from your listing's reviews once it is claimed, and flags a slip of 30% or more.